Obesity and Clinical Activity in Psoriatic Arthritis Patients Treated with Synthetic Disease-Modifying Antirheumatic Drugs

Introduction: Comorbidities are prevalent in psoriatic arthritis (PsA) and which may affect disease activity and response to therapy. Aims: To evaluate comorbidities among patients with PsA naïve to biologics, and their association with basal inflammatory activity status, before starting them. Methods: We performed a retrospective cross-sectional a study of cohort of patients with PsA (CASPAR criteria), treated with synthetic disease-modifying antirheumatic drugs. Patients were managed according to EULAR/GRAPPA recommendations, and the collected variables included demographics, clinical, serological, classical CV risk factors, and treatment. Disease activity was assessed using the Disease Activity Score for Psoriatic Arthritis and clinical DAPSA scores. The tests were two-tailed, with a significance level of <0.05. Results: A total of 416 patients were included in the study: 222 maintained remission or low disease activity being treated without biologics, and 194 who needed to be treated with bDMARD because they did not response well to csDMARD. From patients who were waiting to start biologics, 38.1% had obesity and had increased risk of MetS for age > 50 years old (OR 3.287 [95%CI: 1.258-8.591], p 0.015) and CRP > 0.5 mgr/dL (OR 2.684 [95%CI: 1.141-6.313], p 0.024) but not for cDAPSA>13 (OR 1.539 [95%CI: 0.695-3.409], p 0.288). DAPSA score was higher in patients with obesity, 20.3 (14.4) vs 13.8 (8.5), p0.010 and these patients had an OR for cDAPSA>13 of 3.15 [95%CI: 1.07-9.25], p 0.037). Patients with obesity had a higher frequency of DAPSA and cDAPSA MoDA-HDA (p = 0.022; p = 0.032). In the linear logistic regression analysis, a high-moderate DAPSA score was associated with obesity (p = 0.017), CRP (p <0.0001), and cDAPSA score with obesity (0.029) but not with CRP (p = 0.748). Obesity and corticosteroid treatment were independent factors for cDAPSA>13 and the presence of enthesitis for cDAPSA≤13. Conclusion: PsA patients who did not respond well to csDMARD had a higher prevalence of MetS, associated with age > 50 years and CRP higher than normal values. The DAPSA score was higher in patients with obesity and corticosteroid treatment. Enthesitis was more frequent in patients with low disease activity by DAPSA score.